Healthcare Provider Details

I. General information

NPI: 1841123072
Provider Name (Legal Business Name): MELISSA DEVORA DIAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2208 OASIS PALM CIR APT 201
CAPE CORAL FL
33991-3396
US

IV. Provider business mailing address

2208 OASIS PALM CIR APT 201
CAPE CORAL FL
33991-3396
US

V. Phone/Fax

Practice location:
  • Phone: 786-567-2055
  • Fax:
Mailing address:
  • Phone: 786-567-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-539998
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: